Department of Operative Techniques and Surgical Research, Faculty of Medicine, University of Debrecen, H-4032 Debrecen, Hungary.
The Transplant Institute, Sahlgrenska University Hospital, 413 45 Gothenburg, Sweden.
Int J Mol Sci. 2021 Feb 13;22(4):1864. doi: 10.3390/ijms22041864.
Hepatic ischemia-reperfusion injury (IRI) is a multifactorial phenomenon which has been associated with adverse clinical outcomes. IRI related tissue damage is characterized by various chronological events depending on the experimental model or clinical setting. Despite the fact that IRI research has been in the spotlight of scientific interest for over three decades with a significant and continuous increase in publication activity over the years and the large number of pharmacological and surgical therapeutic attempts introduced, not many of these strategies have made their way into everyday clinical practice. Furthermore, the pathomechanism of hepatic IRI has not been fully elucidated yet. In the complex process of the IRI, flow properties of blood are not neglectable. Hemorheological factors play an important role in determining tissue perfusion and orchestrating mechanical shear stress-dependent endothelial functions. Antioxidant and anti-inflammatory agents, ischemic conditioning protocols, dynamic organ preservation techniques may improve rheological properties of the post-reperfusion hepatic blood flow and target endothelial cells, exerting a potent protection against hepatic IRI. In this review paper we give a comprehensive overview of microcirculatory, rheological and molecular-pathophysiological aspects of hepatic circulation in the context of IRI and hepatoprotective approaches.
肝缺血再灌注损伤（IRI）是一种多因素现象，与不良的临床结局有关。IRI 相关的组织损伤的特点是根据实验模型或临床环境的不同而存在各种时间顺序的事件。尽管 IRI 研究已经成为科学关注的焦点已有三十多年，并且随着时间的推移，出版物的数量不断增加，引入了大量的药理学和手术治疗尝试，但这些策略中并没有多少真正应用于日常临床实践。此外，肝 IRI 的发病机制尚未完全阐明。在 IRI 的复杂过程中，血液的流动特性不容忽视。血液流变学因素在决定组织灌注和协调机械剪切应力依赖的内皮功能方面起着重要作用。抗氧化和抗炎剂、缺血预处理方案、动态器官保存技术可以改善再灌注后肝血流的流变学特性，并针对内皮细胞，对肝 IRI 发挥强大的保护作用。在这篇综述论文中，我们全面概述了 IRI 背景下肝循环的微循环、流变学和分子病理生理学方面以及肝保护方法。
